New 10-bed crisis unit opens at N.H. Hospital, a year behind schedule

  • The nursing station at New Hampshire Hospital’s new 10-bed mental health crisis unit gives staff a clear view of patient bedrooms and a community area. ELIZABETH FRANTZ / Monitor staff

  • New Hampshire Hospital CEO Bob MacLeod talks about the new crisis unit from inside the facility on Tuesday. ELIZABETH FRANTZ / Monitor staff

  • New Hampshire Hospital in Concord as seen on Tuesday, July 5, 2016. (ELIZABETH FRANTZ / Monitor staff)

  • A bedroom inside New Hampshire Hospital’s new mental health crisis unit is seen in Concord on Tuesday, July 5, 2016. (ELIZABETH FRANTZ / Monitor staff)

  • New Hampshire Hospital in Concord as seen on Tuesday, July 5, 2016. (ELIZABETH FRANTZ / Monitor staff)

  • Newly-installed fencing that will provide privacy to admitted patients as they arrive is seen at New Hampshire Hospital’s mental health crisis unit on Tuesday, July 5, 2016. (ELIZABETH FRANTZ / Monitor staff)

Monitor staff
Published: 7/5/2016 6:25:25 PM

After a yearlong delay, New Hampshire Hospital opened a new 10-bed mental health crisis unit Tuesday.

It’s meant to take pressure off local emergency rooms, where patients often languish for days while they wait for a bed to open up at the state-run psychiatric hospital in Concord.

By 11 a.m. Tuesday, two patients had already been slated for admission to the new unit, where that same morning workers checked the information technology system, monitored video camera feeds from each of the empty bedrooms and cleaned pictures hanging on the walls.

The goal of the unit is to stabilize patients within three days, avoiding a mental health crisis that can escalate into a long-term hospital stay.

“The idea here is to get them in as quick as we can, so that we can turn them around and get them back into the community as quick as we can,” said hospital CEO Bob MacLeod. As the state’s only psychiatric hospital, it frequently has a long waitlist.

Construction on the new unit was completed last July, but its opening was delayed largely due to a nursing shortage.

A pay raise approved by the Executive Council this year helped attract more nurses, while a separate contract has brought in temporary staff to fill positions as the new nurses are trained. Only veteran nurses work at the new psychiatric unit.

The unit’s launch, a year late, comes at a tumultuous time for New Hampshire Hospital.

Seven psychiatrists and advanced-level nurses left last Thursday, when Dartmouth-Hitchcock took over medical operations at the hospital from Dartmouth College.

Dartmouth-Hitchcock temporarily reassigned providers from its practice in Lebanon to fill the staffing holes at New Hampshire Hospital. But the shift has led to the temporary closure of nine of the 21 beds at Dartmouth-Hitchcock’s inpatient psychiatric unit in Lebanon.

A psychiatrist brought on more than a year ago to manage the new 10-bed unit was one of the providers who left last week.

In the meantime, the hospital’s chief medical officer will oversee the new unit until permanent staff is put in place.

MacLeod the staff transition has been “seamless” and the hospital will not cut back on its admissions.

“It’s going splendidly,” MacLeod said. “If you did not know this was going on, you would not know this is going on.”

Not everyone thinks the unit’s opening lives up to expectations. Suellen Griffin, executive director of West Central Behavioral Health in Lebanon, had hoped the state would add 10 new mental health beds to the whole tally. But because nine Dartmouth-Hitchcock beds in the Upper Valley are now temporarily unavailable, the state is left with a net gain of one, she said.

“I certainly understand it,” Griffin said, referring to the staffing shift. But “the intent was to add the 10 intake beds, that was the intent, not to just offset them.”

For months, questions about staffing at New Hampshire Hospital have grown. While most of the workers there are state employees, a group of roughly two-dozen psychiatrists, administrators and advanced-level nurses work at the hospital under contract.

Dartmouth-Hitchcock sought to take over that state contract from Dartmouth College’s medical school, which has held it since the 1980s.

The Executive Council approved a contract last month that puts Dartmouth-Hitchcock in charge until the end of October. The state will then decide whether to award the full five-year hospital staffing contract to Dartmouth-Hitchcock or reopen the bidding process.

The transition prompted the labor dispute and last week’s staff departures. Several psychiatrists signed on with Dartmouth-Hithcock, but others said the provider was unwilling to negotiate employment terms and proposed offers that cut benefits.

MacLeod said patient care is not threatened by the changes.

“If I thought that was an issue, I would bring it up,” he said, adding that the eight incoming Dartmouth-Hitchcock physicians are training with the existing hospital psychiatrists. “The doctors coming in are highly qualified. I have no concerns at all.”

Patients admitted involuntarily to one of New Hampshire Hospital’s 158 beds are often experiencing serious mental health issues and have been deemed a danger to themselves or others. Most stay an average of 11 days, MacLeod said, but the median stay is more than 30 days.

The new 10-bed unit will keep patients for a short term, up to 72 hours, and is meant to stabilize those who might have gone off their medication or are familiar faces at the hospital, MacLeod said. Referrals will likely come from emergency rooms and community mental health centers.

The unit provides more of a community setting, MacLeod said. The 10 new bedrooms are situated around a common area equipped with a TV, mounted to the wall behind Plexiglas, and a boom box. The bed and bathrooms are sparsely furnished and designed so patients can’t harm themselves. The sink and toilet pipes, for example, are hidden behind metal paneling. A security camera hovers on the ceiling of each bedroom.

The hospital made additional changes beyond the new unit. A fence lined with privacy panels now encircles the hospital admissions door, so patients are hidden from the parking lot and road when they enter.

“It looks like a small thing, but I’m really thrilled about that,” MacLeod said. “When (patients) get out of the sheriff’s van or an ambulance, they are really not in their best presentation. We want to make it as humanistic as we can.”

Democratic Gov. Maggie Hassan and Health and Human Services Commissioner Jeffrey Meyers applauded the new unit’s opening. Known officially as the 10-bed “inpatient stabilization unit,” Meyers called its launch “an important milestone in addressing the needs of people who are experiencing a mental health crisis.”

(Allie Morris can be reached at 369-3307 or amorris@cmonitor.com.)




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